Policy And Procedure Changes Accepted As Of 5

Transcript

232Environmental/Safety, Policy: 5 – Infection Control A. POLICY It is the policy of Link Associates to maintain and adhere to infection control procedures that shall help prevent or reduce the spread of communicable disease and to assure proper sanitation procedures are followed in all facilities. Link Associates shall follow universal precautions to prevent or reduce the spread of blood borne pathogens. Link Associates shall maintain and document compliance with applicable federal, state and local standards and national accreditation standards. This policy shall be reviewed on an annual basis. B. PROCEDURE 1. Definitions a. Blood borne Pathogens means pathogenic microorganisms that are present in human blood and can cause disease in humans. These pathogens include, but are not limited to, hepatitis B virus (HBV) and human immunodeficiency virus (HIV). b. Body Fluids include the following human body fluids: semen, vaginal secretions, cerebrospinal fluid, synovial fluid, pleural fluid, pericardial fluid, peritoneal fluid, and amniotic fluid, saliva in dental procedures, any bodily fluid that is visibly contaminated with blood, and all body fluids in situations where it is difficult or impossible to differentiate between body fluids. c. Contaminated means the presence or the reasonably anticipated presence of blood or other potentially infectious materials on an item or surface. d. Contaminated Laundry means laundry, which has been soiled with blood or other potentially infectious materials. e. Exposure Incident means a specific eye, mouth, other mucous membrane, non-intact skin, or parenteral contact with blood or other potentially infectious materials that result from the performance of an employee's duties. f. Occupational Exposure means reasonably anticipated skin, eye, mucous membrane, or parenteral contact with blood or other potentially infectious materials that may result from the performance of an employee's duties. g. Personal Protective Equipment is specialized clothing or equipment worn by an employee for protection against a hazard. General work clothes (e.g., uniforms, pants, shirts or blouses) not intended to function as protection against a hazard is not considered to be personal protective equipment. h. Regulated Waste means liquid or semi-liquid blood or other potentially infectious materials; contaminated items that would release blood or other potentially infectious materials in a liquid or semi-liquid state if compressed; items that are caked with dried blood or other potentially infectious materials AND are capable of releasing these materials during handling; contaminated sharps; and pathological and microbiological wastes containing blood or other potentially infectious materials. i. Universal Precautions is an approach to infection control. According to the concept of Universal Precautions, all human blood and certain human body fluids are treated as if known to be infectious for HIV, HBV, and other blood borne pathogens. j. Infestations or contagious illnesses include but are not limited to exposure to bed bugs, head lice, measles, mumps, strep throat, mono, staph infections, MRSA sores, ring worm and athletes foot. C. Exposure Control Plan 1. General Information a. All employees have occupational exposure. Environment/Safety Policy 5: Infection Control Dates Reviewed: 3/13, 2/14, 10/14, 5/16 Date Revised: 3/13, 5/14, 11/14, 5/16 232 191 b. Tasks in which occupational exposure may occur include: providing minor basic first aid, glucose fingersticks, administration of injections (nurse only), and assisting with menstrual care, toileting, and hygiene activities. c. Engineering controls to prevent exposure to blood borne pathogens include sharps disposal containers, disinfectant solution, spill kits specifically designed for blood and body fluids, hand washing facilities, and personal protective equipment. d. Administrative controls to prevent exposure to blood borne pathogens include the use of universal precautions, employee training, and bio hazardous waste collection procedures. 2. Post-Exposure Plan a. In the event of an exposure incident, the employee shall 1) Encourage the wound to bleed, unless contraindicated. 2) For exposure to broken skin (including bites, needle sticks, puncture wounds, and open wounds) wash area with soap and water for 20 minutes. 3) For exposure to the mouth, repeatedly rinse the mouth with water without swallowing for 20 minutes. 4) For exposure to the eye, irrigate the eye with running water (such as in a shower) for 20 minutes. Turn the head so that the involved eye is down. 5) For exposure to the nose, wipe out with damp gauze, changing gauze frequently for 20 minutes. b. The employee shall immediately notify his/her supervisor or the agency nurse. c. The supervisor and the agency nurse shall verify that exposure to blood or a bodily fluid has occurred. d. If it is determined that exposure to blood or bodily fluids has occurred, the supervisor or nurse shall notify the Outreach Director who shall make arrangements for the employee to receive medical evaluation at the appropriate occupational health clinic or hospital. e. Testing, follow-up appointments, and vaccinations must be completed as ordered by the attending physician. The nurse or Outreach Director shall ensure that the Hepatitis B vaccination is offered by a health care facility within 24 hours of the exposure incident. If the employee declines the Hepatitis B vaccination at that time he/she shall sign the First Report of Exposure to Blood and Bodily Fluids Hepatitis B Vaccination form. f. The nurse or Outreach Director shall provide the health care facility with a description of the exposed employee’s duties as they relate to the exposure incident, documentation of the route(s) exposed and circumstances under which exposure occurred. g. The employee shall complete the First Report of Exposure, First Report of Injury, and Safety Committee Incident forms within 12 hours of exposure. h. The nurse or Outreach Director shall obtain and provide the employee with a copy of the evaluating healthcare professional’s written opinion within 15 days of the completion of the evaluation. The opinion shall be limited to the following information: that the employee has been informed of the results of the evaluation and that the employee has been told about any medical condition resulting from exposure to blood or other potentially infectious materials which require further evaluation or treatment. Post-exposure counseling shall be provided by the occupational health staff. D. Hepatitis B vaccinations 1. Employees shall be advised of the effects of the Hepatitis B virus, the vaccine’s benefits and potential side effects by the agency nurse at the initial health screen. At the initial health screen, the new employee and the agency nurse complete the form E-6f (Employee Orientation to Health Services and Related Procedures). The employee shall then accept or decline to receive the Hepatitis B vaccination series and document his/her choice on the form. 2. Employees may receive a Hepatitis B vaccine at any time after the initial assignment. When an employee wishes to receive a Hepatitis B vaccination (even if he/she previous declined), he/she shall contact the agency nurse. The agency nurse or designee shall provide the employee with instructions on making arrangements to receive the vaccine. 192 3. The employee shall also receive a schedule for subsequent vaccinations and it is their responsibility to keep and make arrangements to obtain these. The vaccines are provided at no cost to the employee while employed at Link Associates. E. Methods of compliance 1. UNIVERSAL PRECAUTIONS & PERSONAL PROTECTIVE EQUIPMENT-Universal precautions shall be observed in any situation involving exposure (or potential exposure) to blood and bodily fluids. The appropriate personal protective equipment shall be used in such situations. a. Masks and protective eyewear are to be worn in situations where blood or bodily fluid may come into contact with the mucous membranes of the eyes, nose or mouth. b. Protective (waterproof) gowns are to be worn when blood or bodily fluids may come into contact with skin that is not protected by other personal protective equipment. c. Gloves are to be worn when any contact (or potential contact) may occur with blood or bodily fluids, including (but not limited to) contact with mucous membranes, contact with non-intact skin, performing blood glucose sticks, and handling contaminated items. Gloves should be changed and hands washed between consumers. d. Pocket masks are to be used when giving rescue breaths during CPR. 2. SPILLS-Spills containing blood or bodily fluids shall be cleaned immediately. Fecal matter, vomitus and urine may be carefully poured into a toilet and flushed. (If the toilet becomes contaminated, it shall need to be appropriately cleaned as well.) Other fluids shall be wiped with a disposable wipe. The wipe should be discarded into a bio hazardous waste bag. The area of contamination shall be cleaned with an approved and supplied disinfectant or a solution of 1 part bleach and 10 parts water. 3. LAUNDRY a. Laundry that is contaminated with blood or other potentially infectious materials (OPIM) shall be placed in a waterproof biodegradable laundry bag immediately and the bag shall be sealed. The laundry bag shall be handled wearing gloves and shall immediately be placed in the washing machine. The laundry shall be washed twice in a washing machine on the highest agitation cycle, on the hot water setting, with at least 1 cup of laundry detergent and ½ cup (4 fluid ounces) of bleach. The laundry shall then be dried in a dryer on a heated setting. The contaminated linen may be commercially dry-cleaned instead of laundered at home. b. Laundry grossly soiled with feces or urine (but is NOT contaminated with blood or OPIM) shall be washed alone twice in a washing machine on the highest agitation cycle, on the hot water setting. Formed feces should be disposed of into the toilet before laundry is placed in the washing machine. 4. WASTE DISPOSAL a. Regulated waste shall be disposed of in waterproof, red bags with the biohazard symbol (four interlocking circles) and the word “BIOHAZARD” printed on them. The waste shall be brought to the nurse’s office and placed in the 5-gallon red container, marked biohazard. The nurse shall arrange for the disposal of the 5gallon red biohazard container through Metro Hazardous Waste. If regulated waste is generated at a location other than the administration building, it must be double bagged in red biohazard bags before transport to the administration building. The method of double bagging must ensure that absolutely no waste can spill outside the bags. The bag should be placed in a location in the vehicle of transport that is not near people (i.e. the trunk) and should have ample room (i.e. should not be “squeezed into place”). If generation of regulated waste becomes a regular occurrence at a location other than the administration building, a red, biohazard container shall be placed at that location. b. Soiled sanitary napkins shall be wrapped in toilet tissue and placed in a leak-proof bag that lines a container. Every twenty-four hours (if the container has been used), the liner shall be removed, placed in a plastic bag, sealed, and taken to the dumpster. The container shall then be cleaned with a disinfectant solution. 193 5. SHARPS DISPOSAL-Gloves shall be worn when using any needles, syringes or sharp instruments. Sharps are not to be recapped and shall be disposed of immediately after use. Used sharps shall be placed into a puncture-resistant, leak-proof, red, biohazard-labeled container. The sharps container shall be in close proximity to the area of use. When syringe containers are full they are to be properly sealed, with lid in place and brought to the nurse’s office. The nurse shall dispose of sharps containers and other bio hazardous waste in a manner complaint with federal, state and local regulations. 6. HANDWASHING-Hand washing is the most effective way to prevent the transmission of diseases. A paper towel (or individual hand towels at the homes) shall be secured before washing hands. Hands shall be wetted and soap applied. Hands shall then be rubbed together for at least 15 to 20 seconds, and then rinsed with running water. After drying hands, the paper towel should be used to turn off the faucet, and then discarded. Hand washing for employees and consumers should occur: a. At the beginning and end of a work shift b. Whenever hands are obviously dirty c. After contact with mucous membranes, blood or bodily fluid (i.e. rubbing eyes, blowing nose) d. Before and after any kind of first aid care or dressing change e. Before and after using the restroom or assisting consumers in using the restroom f. Before and after eating and assisting consumers with eating g. Before, during, and after food preparation, especially after handling raw meat products h. After general household or facility cleaning, garbage removal, and handling soiled linens or clothing i. After removing gloves j. Before and after assisting consumers with personal hygiene k. Before and after medication administration 7. GENERAL CLEANING- All facilities and residences shall be maintained in a generally clean, hygienic and organized manner. a. Bathrooms shall be cleaned daily in the Link Associates Administrative Office. An antimicrobial cleaner shall be used on the sink, tub/shower and the toilet and the floor shall be mopped with each cleaning. The frequency of bathroom cleaning at the residential locations shall be determined by the residential supervisor of each location but shall not be cleaned less than once per week. Hand urinals shall be disinfected after each use. Each resident shall have his/her own towel to use for after hand washing or disposable towels may be used. Cloth towels shall be laundered and replaced at least weekly, more often if soiling occurs. b. Dining area tables shall be wiped off and disinfected after each snack and meal, or after activities as indicated. All work surfaces in the vocational and day habilitation areas shall be disinfected daily. c. All floors shall be either vacuumed or swept and mopped at least weekly, more often if indicated or in areas of high traffic. Mop heads shall be laundered between uses. If the mop has a non-washable mop head, it shall be thoroughly rinsed in hot water. d. Trash receptacles shall be lined with plastic liners. Trash shall be removed whenever receptacle is reasonably full, at least weekly. Trash receptacles shall be rinsed and sanitized whenever indicated, at least monthly. e. Kitchen surfaces (counters, stove top, microwave, etc.) shall be wiped with a disinfectant solution after each meal. Kitchen towels, cloths and sponges should be laundered and replaced at least every three days for residential locations and at least daily for the lunchroom, more often if soiling occurs. Ovens interiors shall be cleaned at least every three months, and more often if food spills or grease are present indicated. Refrigerators should be cleaned weekly by disposing of outdated food and wiping any spills. 1) Dishes shall be washed in the automatic dishwasher when available. At a Residential Care Facility, bleach shall be added to the dishwasher per instructions on the dishwasher log sheet. The amount of bleach shall be tested for monthly with test strips to ensure 50-100 bleach parts per million is accomplished. 194 2) When an automatic dishwasher is not available, dishes shall be washed in hot, soapy water and rinsed in the hottest water possible. f. All hard-topped surfaces shall be dusted at least monthly. g. Floor mats and changing tables shall be wiped off after use. h. Laundry shall be washed in a washing machine with an appropriate amount of laundry detergent. i. Drinking fountains in the main facility shall be disinfected each workday. j. Healthcare equipment shall be cleaned as follows: 1) Oral thermometers shall be used only with disposable covers and cleaned after use with soap and water, then cleaned with alcohol. 2) Stethoscope heads shall be wiped with alcohol between uses on individual consumers. 3) Blood pressure cuff becomes contaminated with blood; the outer cover of cloth material shall be removed and washed per contaminated linen procedure. Other parts of the cuff (such as the metal, rubber or plastic parts) shall be cleaned thoroughly with alcohol or as directed by the manufacturer. 8. FOOD PREPARATION a. Refrigerators and freezers shall be kept free of food that is inedible or unsafe to eat. Food and beverages shall be kept covered. Refrigerator temperatures shall remain between 34 and 40 degrees Fahrenheit. b. Foods shall be thawed in the refrigerator (not on the countertop). c. Perishable foods shall be refrigerated in a timely manner. d. Persons with communicable diseases (including colds) shall not participate in the preparation or service of foods or beverages. e. Utensils, plates, bowls or cutting boards that have been used to handle raw meat shall not be used again until they have been properly cleaned. 9. SPECIAL HEALTH CARE CONSIDERATIONS A consumer shall not be admitted to (or remain in a program) if he/she has medical needs that cannot be reasonably met by his/her program(s). If consumer needs specific cares, such as, but not limited to: oxygen, urinary catheter, feeding syringes, intravenous or central line, ostomy, or respiratory suctioning, specific guidelines for cares shall be written by the nurse. Written copies of the procedure for the cares shall be distributed to the appropriate employees and their supervisors and copies shall be kept in the residential on-call book (as applicable) and in the consumer’s vocational area or residence (as applicable). The nurse shall provide initial training for all employees for new special procedures. The supervisor shall train new employees for existing special procedures that are in place at the time of a new employee’s hire. The nurse shall be consulted promptly if any questions or problems arise. 10. Communicable Diseases a. ATTENDANCE - Employees or consumers that have had diarrhea, vomiting, a fever of 100 or more, or are suspected of having a communicable disease (including head lice) shall be excluded from attending work, vocational, or day programs respectively. The employee or consumer may return to work, vocational, or day program once he/she is no longer contagious b. LICE 1) RESIDENTIAL - If a residential consumer is found to have head lice, the consumer’s housemates shall also be checked for head lice and treated if necessary. Treatment shall be with a permethrincontaining agent (such as Nix or Rid) according to the package directions. The consumer shall be rechecked daily for head lice beginning the seventh day after treatment for the following five days. The consumer’s residence shall be treated for lice in the following manner: a) Bedding and clothing belonging to a consumer with head lice shall be laundered and dried for at least 20 minutes on high heat. b) The consumer’s combs, brushes and hair ornaments shall be placed in boiling water for 10 minutes. c) The floors, upholstered furniture and mattress shall be thoroughly vacuumed. 195 d) Stuffed animals and any other objects that cannot be placed in hot water may be either placed in a sealed plastic bag for 10 days OR sprayed with a lice control spray that contains permethrin, such as Nix Lice Control Spray. e) In cases of recurrent lice, a consumer’s health care provider shall be consulted and lice control spray shall be used on the carpets, upholstered furniture and mattress. 2) VOCATIONAL - If a vocational or day habilitation consumer is found to have head lice, the consumer shall be sent home immediately, but may return after he/she has been properly treated for head lice. Consumers and staff that have had close contact with the infected consumer shall be checked for head lice. Notes shall be sent home with all consumers in a program area if three or more cases of head lice are found within one week in that program area. 3) BED BUGS a) At one-time bed bugs were almost eliminated from the United States, but are currently found in all states. Bed bugs do not transmit disease. Link Associates’ views this as a no-fault situation. It is impossible to determine where an exposure started. b) At all sites, staff should report bed bugs identified to their immediate supervisor. Support, information, supplies and direction will be provided. c) To ensure the bed bugs are not transferred from a Link site to staff home or from staff home to Link site, Link strongly encourages that all employees at the site have their personal homes inspected for bed bugs to significantly reduce the likelihood of spreading bed bugs from one location to the next. d) Link Associates has arrangements with a licensed pest controller to provide a free bed bug inspection at staff homes. e) Should it be determined a staff’s home is also affected, they will be asked to take the appropriate actions, at their own cost to prevent the spread. Their return to their work site will be coordinated by their immediate supervisor and the Fleet & Facilities Director based on proof of treatment. c. EMPLOYMENT Per Iowa Code 481-63.11(1)c.(1) Link Associates shall not employ any individual if the person has a disease: 1) Which is transmissible through required workplace contact and 2) Which presents a significant risk of infecting others and 3) Which presents a substantial possibility of harming others and 4) For which no reasonable accommodation can eliminate the risk. d. EMPLOYEE HEALTH SCREENING Potential employees shall have a tuberculin test and health screen with the Agency nurse before employment. In the event that a tuberculin test is positive (or a history of positive tuberculin test is known) a chest x-ray shall be done. Tuberculin tests done elsewhere shall be accepted as proof if done within the last 12 months and a valid written record is provided. Potential employees and current employees who work in a Residential Care Facility (RCF) follow the guidelines in the subsequent section of Infection Control – RCF/ID. 11. Employee Training a. A new employee shall briefly review the universal precautions policy with the agency nurse during his/her initial health screen. b. A new employee shall make every effort to attend the Universal Precautions class within the first 30 days of employment. A new employee is required to attend the Universal Precautions Class within the first 90 days of employment and to complete the Universal Precautions In-service annually thereafter. c. A copy of OSHA’s blood borne pathogens standard shall be available through the Agency Nurse by request at any time. d. Annual training shall include information required by OSHA standard 1910.1030(g) (2) (vii) and (viii), summarized on the OSHA & Universal Precautions form. e. If changes in tasks or procedures occur, that affect the employee’s occupational exposure, additional training shall be provided by the Agency Nurse. 196 12. Record Keeping 1. Records regarding exposure incidents shall be kept in compliance with OSHA standard 1910.1030(h)(1)(iiv). 2. Training records shall be kept in the employee’s personnel file and shall be in compliance with OSHA standard 1910.1030(h) (2). 3. A sharps injury log shall be maintained by the nurse in compliance with OSHA standard 1910.1030(h) (5). 4. Exposure records shall be maintained for the duration of employment plus 30 years in compliance with OSHA standard 1910.1030h1IV. 197 Link Associates Infection Control RCF-ID A. General 1. Disinfectant solution to be used shall be 1-part bleach to 10 parts water (or a commercially available equivalent), unless otherwise indicated. 2. Wastebaskets shall be lined with plastic liners and trash shall be emptied daily. Wastebaskets shall be disinfected weekly. 3. All hard-topped surfaced shall be dusted weekly. 4. All carpeted areas shall be thoroughly vacuumed weekly. 5. All floors, carpets, baseboards and windows throughout the home shall be thoroughly cleaned quarterly. 6. Cleaning agents shall not be accessible to residents except as indicated in a resident’s CCSP. 7. Residential Care Facilities shall also adhere to Iowa Code 481-63.24(135C) for housekeeping, maintenance, laundry and waste disposal regulations. B. Kitchen/food preparation 1. Persons with any communicable disease (including colds) shall not be allowed in the food preparation area. 2. Residents shall not be allowed in the food preparation area unless specified in their CCSP. 3. Residents shall be closely monitored while preparing/serving food and/or beverages. 4. Hair shall be covered with hairnets. 5. Hands shall be washed before and after food preparation and after handling uncooked meat. 6. Utensils and dishes that are used to handle uncooked meat shall not be used to handle cooked foods until properly washed. 7. Cutting boards shall be used if necessary during food preparation and disinfected after use. 8. Foods placed in the refrigerator shall be labeled and dated. These foods shall not remain in the refrigerator longer than five days. 9. No perishable food shall be allowed to stand at room temperature any longer than is required to prepare and serve it. 10. Poisonous compounds shall not be stored in the food preparation area. 11. Food shall not be used if it is damaged or from an unlabeled container. 12. A minimum of a two-day supply of food shall be kept on hand at all times. 13. Residential Care Facilities shall also adhere to Iowa Code 63.19 (1-6) for additional food service regulations. C. Kitchen cleaning 1. The dining room tables shall be cleaned and disinfected before and after each meal. 2. The dining room chairs shall be cleaned and disinfected after each meal using warm, soapy water. 3. The kitchen and dining room floors shall be cleaned and disinfected at least three times per week, more often if indicated. (A separate, labeled, mop shall be used for the kitchen and bathroom.) 4. Kitchen towels and cloths shall be replaced after each meal. 5. Kitchen and dining room floors shall be swept after each meal. 6. Dishes shall be washed promptly after each meal in an automatic dishwasher. Bleach shall be added to the dishwasher per instructions on the dishwashing/bleach log. Dishes shall be air-dried or may be automatically dried by the dishwasher. Towel drying shall not be allowed. 7. Pots and pans may be washed by hand. The sink must be cleaned before use to wash any food service items. They shall be washed in hot soapy water, rinsed, air dried and put away after each meal. 8. Ovens interiors shall be cleaned after each use of any food particles and grease. 9. Refrigerators shall be cleaned weekly. 10. All food contact surfaces of stoves, countertops, griddles, and similar cooking devices and similar cooking devices as well as the cavities and door seals of microwave ovens shall be cleaned and disinfected after each meal. Surfaces that held uncooked meat shall be cleaned and disinfected with bleach solution. 198 D. E. F. G. H. I. 11. Clothes or sponges used for cleaning shall be clean and rinsed frequently in disinfectant solution and will be stored in this solution between uses. Bathrooms 1. Disinfect sinks, faucets, faucet handles, floors, toilets and countertops daily. (A separate, labeled, mop shall be used for the kitchen and bathroom.) Soft Scrub (or a similar cleaner) may be used to disinfect the sinks. 2. Disinfect showers and tubs between uses by individual consumers. 3. Liquid soap and paper towels shall be available for use in each bathroom. 4. Soiled sanitary napkins shall be wrapped in toilet tissue and placed in a leak-proof bag that lines a metal container. Every twenty-four hours (if the container has been used), the liner shall be removed, placed in a plastic bag, sealed, and taken to the dumpster. The metal container shall then be cleaned with a disinfectant solution. Floor Cleaning 1. Separate mops shall be used for the kitchen and bathrooms. These mops shall be labeled accordingly. 2. Use a disinfectant solution for mopping. 3. Used mop water shall be dumped into the utility sink in the laundry room or janitor’s closet promptly after use. 4. Mops heads shall be changed after use. 5. Mop heads shall be washed weekly in a solution of ½ cup of bleach per load (or a commercially available equivalent) and dried thoroughly. 6. Mops and buckets shall be stored in the utility closet. Laundry 1. Kitchen linens shall be laundered separately from bathroom linens. 2. All towels shall be washed in the hot wash cycle. 3. Each resident’s clothing shall be laundered at least weekly. See Environment/Safety Policy 5: Infection Control for guidelines on washing clothes that have blood or bodily fluids on them. Outdoors and storage areas 1. Hallways and corridors shall be kept clear of furniture. 2. Odors shall be kept under control by cleanliness and proper ventilation. 3. Polishes are not permitted on floors unless they are of the non-slip finish variety. 4. Throw or scatter rugs are not permitted. 5. Entrances, exits, steps and outside walkways shall be kept free from ice, snow and other hazards. Employee Health Screening Potential Employees of Residential Care Facilities (RCF) shall have a physical examination/health screening at an occupational health facility before employment. A 2 step TB skin test will be administered by the agency nurse. In the event that a tuberculin test is positive (or a history of positive tuberculin test is known) a chest x-ray shall be completed. Written documentation of the 2 step TB skin tests and results OR a chest x-ray and results will be accepted if completed and dated within 12 months of hire. The physical examination at an occupational health facility is still required prior to working in a RCF. Tuberculosis (TB) 1. TB screening plan Link Associates TB screening plan comprises four major components; a. Baseline testing for M tuberculosis infection which is accomplished through agency consumer admission guidelines and new employee health screen procedures, and consists of two components; 1) Assessing for current symptoms of active TB disease and, 2) Using a two-step tuberculin skin test or a single interferon gamma release assay test b. Serial testing for M. tuberculosis infection, c. Serial screening for signs and symptoms of TB disease 1) Low risk classification – additional TB screening not necessary 2) Medium risk classification – TB screening annually 3) Potential ongoing transmission classification – TB testing may need to be performed every 8-10 weeks until no additional evidence of transmission is apparent 199 d. TB training and education which is provided to all staff upon hire and annually. 2. TB risk assessment Annually a TB risk assessment will be conducted to evaluate the risk for transmission of M. tuberculosis regardless of whether a person with suspected or confirmed TB disease is expected to be encountered. This will be utilized to determine the types of administrative, environmental, and respiratory protection controls needed and will serve as an ongoing evaluation tool of the quality of the TB infection control measures. The risk assessment will include; a. The community rate of TB b. The number of persons with infectious TB encountered in each of the RCF/ID group homes c. The speed with which persons with infectious TB disease are suspected, isolated, and evaluated to determine if persons with infectious TB exposed staff or others in the home. TB cases include persons who had undiagnosed infectious pulmonary or laryngeal TB while in the home during the preceding year. This does not include persons with Latent TB infection (treated or untreated), persons with extra pulmonary TB disease, or persons with pulmonary and laryngeal TB that have met criteria for non-infectiousness. 3. Infection Control Team/Risk Classification Link Associates Health Services Administrator is the designated staff responsible for determining the type of risk classification associated with the RCF/ID homes and for completing the TB risk assessment. The person in this position must be a nurse licensed in the State of Iowa and properly trained to screen for TB and perform TB testing. This will be documented on the TB Risk Classification form. The original will be filed in the administrative files with copies located in the RCF/ID home and with the Corporate Operations Director. 4. Additional information Iowa Administrative Code, Chapter 59, Tuberculosis Screening contains much more detailed and specific details dependent upon the many variables that could occur or exist in the TB plan and assessment and will be the reference for additional guidance in conjunction with the Department of Inspections and Appeals, Centers for Disease Control, and the Iowa Department of Public Health. 200 Infection Control - Vocational/Day Programs A. Vocational & Day Program Areas Link employees a professional cleaning crew to maintain the 29th Street facility. They are responsible for routine cleaning of floors, cafeteria, drinking fountains, stairwells, elevators, and bathrooms. If staff need to supplement their cleaning the following shall be used. 1. For equipment cleaning use an approved and supplied detergent and disinfectant solution or a bleach solution (1 part bleach to 10 parts water) 2. Wastebaskets shall be lined with plastic liners and trash shall be emptied daily. Wastebaskets shall be disinfected at least monthly. 3. Floor mats and changing tables shall be wiped off with a disinfectant solution after each use. 4. Consumers shall be strongly encouraged to wash their hands before and after meals and after toileting. B. Lunchroom 1. Dining tables shall be wiped off and cleaned and disinfected after each meal, or after activities as indicated. 2. Cloths used for cleaning shall be changed daily or after heavy soiling. 3. Dining chairs shall be wiped off each week. A different cloth shall be used for the chairs than is used for the tables. 4. Floors shall be swept and mopped daily, more often if indicated. 5. Food older than 5 days shall be removed from lunchroom refrigerators each week and the refrigerators shall be wiped clean. 6. Countertops and microwaves (outside and inside surfaces) shall be disinfected daily. 7. Vending machine buttons and food retrieval areas shall be wiped with disinfectant weekly. 201 Infection Control – General Store A. Cleaning Shelves 1. Clean shelves and clean products not only enhance the appearance of the store, but will also increase sales. It is important that all of our products are fresh and are not faded or damaged. 2. A customer who purchases an outdated or stale item is not going to be happy with the store or Link. Products that are faded or damaged will continue to sit on the shelves forever. 3. If a customer sees dirty, faded, outdated or damaged products in the store, they assume everything in the store is the same way and will take their business to another store that provides clean, quality merchandise. B. Cleaning Shelves Process 1. Starting with the top shelf, remove approximately two (2) feet of product. 2. Check for expired dates or produce that is damaged or faded. Place any damaged or outdated product in the designated area and leave a note for the store manager. 3. Using a damp cloth, wash the shelf, center rail, and the front shell track thoroughly and wipe off each product except for product in paper containers. The damp cloth will damage the boxes. Use the feather duster to remove the dust from these products. 4. Replace the product on the shelf. The following apply whenever stocking or cleaning a. Always place the product on the shelf with the oldest dated product in front. This ensures that our stock is being rotated and our customers will find fresh products on our shelves. b. Place the product to the very edge of the shelf in a straight line. c. Make sure the font of the product is displayed. 5. When finished cleaning and stocking the shelves, stand back and look at the shelves. The product should be placed at the edge of the shelving, the front label of the product facing you and in a neat straight line with no spaces between them. C. Cleaning the Donut Case 1. Consolidate the donuts to 1 or 2 trays and take to the designated area. Box these items, as the morning person will take care of the leftover bakery items the next morning. 2. Remove the donut boxes and sacks and wipe the deco’s from the bottom of the donut case, the metal tracks for the sliding glass doors and the front ledge of the donut case if applicable. 3. Using a cloth and cleaning solution, thoroughly clean the wire racks, the bottom, the metal tracks and all of the laminated parts of the donut case. Change the cleaning water anytime it becomes dirty. 4. Using windows cleaner clean each pane of glass (inside and outside of the donut case). 5. Return the donut boxes and sacks to their designated areas. 6. Return the tray(s) of baker products to the donut case. D. Sanitation 1. General Store personnel do a good job of serving safe food to our customers. However, there is always room for improvement. We must continue to improve our sanitation practices to protect our customers and employees. 2. State and local health codes consider many of our food service products to be “potentially hazardous foods”. We must consider all of these items hazardous and handle each with proper care. 3. Contamination can occur in three specific ways. Each method is defined below. a. Biological hazards 1) Bacteria, viruses, parasites and fungi • These hazards can cause food-borne illnesses such as hepatitis A, E.coli, staphylococcus, listeriosis, salmonella, norovirus and shigellosis. • Symptoms include abdominal pain, headache, nausea, vomiting, diarrhea, dehydration and fever. • Employees diagnosed with hepatitis A, e. coli, salmonella, staphylococcus, norovirus or shigellosis must notify the store Manager immediately. The store Manager must notify the Administrator and the local health authorities. The infected employee’s identity is to remain 202 confidential. That employee may not be allowed to work in the food preparation are until cleared by a physician’s release. 2) Controls include • Proper personal hygiene • Storage of all food items at correct temperatures • Preparation of all food items at correct temperatures b. Chemical Hazards 1) Contamination of food products can occur from improper handling of pesticides, cleaning and sanitizing supplies, personal supplies or paints. 2) Controls include: • Keep food covered at all times • Follow directions when using chemicals • Store chemicals in original containers and away from food and food-contact areas • Properly identify spray bottles containing chemicals • Food items and containers must be stored at least six (6) inches off the floor. c. Physical hazards 1) Physical hazards include dirty hair, bandages, metal fragments, fingernails, and jewelry 2) Controls include: • Removal of all jewelry during food preparation • Keep air vents free form dust particles • Dispose of unused cardboard cases immediately after use • Keep fingernails trimmed and wear foodservice gloves when necessary • Keep bandages secure 3) It is a necessity to retire employee from working in a foodservice establishment when they are ill with diarrhea, fever, sore throat, colds, respiratory infection or burns. Allowing employees to work may cause other workers, customers and food to become infected. d. Personal Hygiene 1) Contamination can be prevented by insisting that foodservice workers practice good personal hygiene. Practices that are of value are: • Good personal hygiene includes washing forearms, hands and fingernails with a nail brush and warm soapy water for a least 20 seconds in the hand sink only and putting on new foodservice gloves. This must be done before engaging in food preparation, after using the restroom, coughing, sneezing, using handkerchief or disposable tissue, head or body scratching, smoking, eating, drinking, wiping up spills on the floor, handling mop head, any other nonfood related activity. • Food handlers must wear clean uniforms, aprons and foodservice ice gloves. This may come in contact with food during preparation or serving and need to be treated as food contact surfaces. • Be sure to remove your apron, cap and foodservice gloves anytime you leave the kitchen. This will ensure that the apron and cap will remain clean and are not contaminated by an outside source. When you return to the area, put on your apron, cap, wash your hands and put on new foodservice gloves. • Keep fingernails unpolished and cut short to avoid dirt and germs under nails. Pathogenic bacteria are most often spread by hands and can be passed to food ruing preparation. The food preparation worker is the one who is responsible for most food poisoning incidents. 2) Keep hands away from your mouth, nose, hair and abrasions on the body as this causes most foodborne diseases. Thorough washing of hands, nails and forearms and replacement of foodservice gloves must follow contact with any of these areas. 3) Minor cuts and scrapes on food handler’s hands or fingers must be covered with a bandage and foodservice gloves. This will prevent possible contamination by the cut or sore bleeding through the bandage or by a dirty bandage. 203 4) Hair must be restrained or tied back to keep if from getting in the food. The hairnet is the best possible restraint and should be used in addition to the visor. Hair in food is a source of bacteria. 5) Food handlers must bathe and shampoo daily to avoid objectionable body odor and to insure that their bodies don’t harbor excessive bacteria. 6) Foodservice gloves must be used during food preparation and when transferring cooked or prepared foods to containers or display trays. 7) After handling money, wash hands and put on new foodservice gives before handling food because hands can become contaminated by dirt and germs from the money and then transferred to the food. 8) The Store manager will review and obtain the appropriate signatures of the store employees on the Food Employee Interview form. 9) All General store employees are required to review and sign the Food Employee Reporting Agreement 4. Snack Center a. Stock the Snack Center 1) Check the cups in the cup dispensers by pushing on each size of cup to see if they are full or if there is room to insert additional cups. 2) Check the coffee supplies such as coffee packets, coffee filters, and cappuccino packets and stock any that are low 3) Check all of the items located in the condiment tray and stock any that are low. 4) Check the napkins in the napkin holder (s) by pushing on the napkins to see if they are full or if there is room to insert additional napkins. If there is room for more napkins, push in on the napkins and press the release lever located inside the dispensers on the right-hand side. Pull the front of the dispensers towards yourself and stock the napkins. 5) Since this is a self-service area, there will be times when there are spills or litter that will need to be cleaned up. As we want this high traffic area to be clan and stocked at all times, employees should check it often during their shift. A spray bottle of sanitizer is to be kept in the snack center for cleaning up spills. Monitor the snack center area carefully and frequently. b. Nightly Cleaning of the Snack Center 1) Remove the tea urn, wash, rinse, and sanitize. 2) Thoroughly clean the fountain pop dispenser and cappuccino machine. Be sure to fill the pop machine with ice, if applicable. Check to make sure the cappuccino machine contains product. 3) Using a cloth and cleaning solution, wipe off the side, back, counter top, and the front of the snack center. Open the microwave and wipe out the inside. 4) Wipe off the side, top, front and underneath the napkin holder and condiment tray. 5) Wipe the metal front of the napkin holder dry with a white paper towel. This will eliminate any streaks of water spots. 6) Do not pour hot liquids or water in fountain drain tray. Pump one squire of sanitizer into the fountain drain at close to help prevent bacteria or mold growth. c. Once A week cleaning of the Snack Center 1) Remove all items from the drawers and cabinets around the coffee and snake center 2) Remove the trashcan from the trash container cupboard. 3) Wipe out the insides of all drawers and cupboards. 4) Ensure that having another employee lift the equipment that can be lifted can clean the entire shelf. 5) Wipe off the cup dispensers and lid holders 5. Fountain Pop a. Cleaning the Fountain Pop Machine 1) *Place an Out of Order sign on the pop machine to avoid customers from getting sprayed with pop, or lock the machine if a key is available. 2) Remove the nozzles from the dispensing valve. 3) If the diffusers are removable, gently pull them straight down to remove. 204 4) Wash rinse and sanitize them. Use the small brush in the brixing kit to clean the inside of the nozzles and the diffusers, if applicable. Never soak the pop nozzles or diffusers in bleach, the bleach will damage the nozzles and diffusers. 5) Remove the grate from the drain pan and wash, rinse and sanitize it. 6) Using a cloth and warm water wipe down the sidewalls of the drain pan. 7) Pour warm water down the drain in the drain pan. Never pour drain cleaners, ammonia, or bleach down the drain. 8) Return the grate to the drain pan. 9) Using a cloth and cleaning solution, wipe off the sides, top and front of the fountain pop machine. 6. The Coffee Maker a. Nightly Cleaning 1) Flip all the coffee maker warmer switches to the off position and clean the coffee maker. 2) Remove the funnel brewer to access the spray head 3) Remove the spray head. The area around the spray head should be wiped clean daily. Neglecting this area can result in bitter flavors. 4) Clean the spray head. A dirty spray head can become partially clogged and cause erratic water flow. Removal and daily cleaning will help avoid inconsistent coffee quality. 5) Clean the water and delivery lines. Insert the del-liming spring into the spray head opening until approximately one inch of the spring is visible. Move the spring back and forth five or six times. This will free the water tube of mineral deposits. Replace the spray head. 6) Clean the brewing funnel and coffee pots daily to prevent off-flavors in the coffee. 7) Replace the wire support in funnel correctly (if one exists) and replace the funnel. 8) Clean the machine. Wipe the entire surface of the machine with a clean damp cloth. Wipe dry. 7. Cappuccino Machine a. Prior to beginning, review diagrams and description of parts on the inside of the door. b. Turn the rinse switch to the On position, place a 16-ounce coffee cup under the first dispensing nozzle, push and hold the dispensing button until the cup is ¾ full. Repeat this procedure twice for each dispensing nozzle. Turn the Rinse Switch to the Off Position. c. Open the cabinet door, turn the chutes on the hoppers upwards, remove the hoppers from the cabinet, place on the counter and remove the chutes. A small amount of cappuccino powder may fall from the hopper. d. Remove the dispenser caps by turning clockwise and pulling up, remove the mixing bowls by pulling up and out of the mixing socket and remove the extension tubes by pulling down. 1) DO NOT REMOVE THE WHIPPING CHAMBERS 2) Rinse the chutes, dispenser caps’, mixing bowls, and extension tubes with warm water. 3) Dry thoroughly and reassemble the parts making sure the mixing bowls are pushed into the mixing bowl sockets and that he dispenser caps are turned until they are secure. 4) Fill the hoppers with the correct product and place in the machine and turn the chutes downwards. 5) Make sure the tube on the back of the hoppers is over the auger gears and the tabs on the bottom set into the holes in the shelf 6) Remove the entire drip tray and grill b7y pulling it completely out of the machine 7) Wash, rinse, dry thoroughly and place back in the unit. Wipe off the sides, top, and front of the cappuccino e. Once a Month Cleaning 1) After removing the hoppers and chutes, pour the cappuccino powder into two-quart containers with lids. 2) Rinse the hoppers in warm water and place upside down on a donut wire rack to air dry overnight. • Do not disassemble the hoppers. All parts are to remain intact. • The next morning fill the hopes with the correct product and place in the machine making sure they are properly seated. 205 • Make sure the hopper is completely dry before refilling. If not, the moisture will cause the powder the power to thicken and clog the auger gear. 3) Refilling the Hopper • Open the cabinet door, turn the chute on the hopper upwards, remove the hoper from the cabinet, place on the counter and fill each hoper with the correct product. The hopper will hold two full bags of product. • Do Not use partial bags of product to fill the hopper. Using only full bags will ensure freshness. • Place the hopper in the machine (make sure it is properly seated) and turn the chute downwards. 8. Food Warmers a. The Food warmers are used to provide ready to eat foodservice items for our customers. Our customers are usually in a hurry and do not have time to wait for an item to be prepared. By having our foodservice items displayed, the appearance and aroma will sometimes entice a customer to purchase an item without planning to do so when they came into the store. b. The Warmers will take approximately 15 minutes to reach the desired temperature. 1) Turn the power switch on. 2) Periodically check the warmer to determine if the temperature has reached 160 degrees. Adjust the temperature dial until the correct temperature has been reached. 3) Turn the humidity dial to reach medium humidity. 4) Pour tap water into the “Water Fill” opening until the level indicator is correct. c. All Products have a shelf life of 1 hour. d. Displaying the products 1) The amount of product that you will display will depend upon the demands of your customers. Make sure all the products are fresh, properly wrapped, and available. Also make sure the time the item was placed in the warmer is on the bottom of the packaging. 9. General Cleaning a. Shelves, Walls, and Light fixtures 1) The shelves, walls and light fixtures are to be cleaned when needed. 2) Remove all of the items from the shelves 3) Using a cloth and cleaning solution, wash the shelves and walls thoroughly by washing the shelf, rails, and the front of the shelf thoroughly. Change the cleaning water anytime it becomes dirty. 4) Using a damp cloth, wipe off the items that were removed from the shelves unless they are cardboard or paper that would be damaged by a damp cloth. 5) Place the items back on the shelves in a neat organized manner. Make sure that all of the items have labels that can be seen at a glance. This will eliminate having to take items from the shelf to determine what they are. 6) Wipe off the light fixtures with a dry cloth. b. Window Cleaning 1) Cleaning Interior Windows, Display Cases, and Doors 2) Spray approved glass cleaner onto surface to be cleaned and wipe with clean, dry paper towels 5. Backroom/Storage Room 1. Even though the customers never see the store’s storage room, it is still an area that must be kept clean and organized. If the storage room is clean and organized, the employees will be able to find the back stock that they need. 2. The storage room is to be straightened and the floor swept and mopped every night. The floor is to be waxed when needed. 3. Cleaning the Storage room nightly a. All back stock is to be straightened, organized and placed in their designated area. b. Sweep under the shelves, in the corners and the walkway. c. Using a cloth and cleaning solution, wipe the front and back of the door, clean wall as needed, clean shelving and place product on shelves 206 d. Mop the floor under the shelves, in the corners and the walkway. Change the mop water anytime it becomes dirty. 4. Floor Care a. Daily Floor Care 1) The daily maintenance of the store’s floor is each employee’s responsibility and is essential to the overall appearance of the store. By keeping the mat clean (if applicable), less dirt will be tracked in on the floors. The first thing a customer sees when they walk through the door is the floor. A clean floor will give a good impression to customers. 2) Removing Tar or Scuff Marks - Using the dull side of the blade on the long handled scraper, lightly scrape the tar or scuff marks. 3) Removing Gum-Place an ice cube directly on the gum and rub it until the gum becomes hardened. Make sure you were appropriate gloves. Using the dull side of the blade on the long handled scraper, lightly scrape the gum off the floor. 4) Dust Mopping the Floor-Before each shift ends, dust mop the floor and then wet mop the floor. Move all the floor mats outside, weather permitting and sweep off the dirt. Always pick up the floor mats as soon as they are swept off. 5) Roll the mats up and place them in an area of the walkway until they are ready to be put back down. If the floor mats are dirty and need to be taken to the car wash, roll them up and place in the designated area either in the backroom or maintenance are until they can be taken to the car wash. The store should always have two sets of floor mats, the one currently being used and a clean set in the backroom/maintenance area. b. Mopping the Store Floor - After the floor is dust mopped, it will be necessary to mop the floor before the shift ends. The floor should also be mopped during inclement weather, after a deliver person leaves the store, or anytime the floor need to be mopped. 1) Product: Agency Approved cleaner (detergent) 2) Equipment: • Wet Floor Signs • Plastic Mop Handle • Long handle Scraper • Dust Mop • Mop Bucket and Wringer • Clean Mop Head • Broom and Dust Pan • Rubber gloves & goggles 3) Procedures: • Assemble the equipment • Remove any freestanding objects • Clean the floor mats and set aside • Dust Mop the entire floor • Remove any gum or debris stuck to the floor with the long handle scraper • Post-Wet Floor Signs • Use all necessary safety equipment • Fill the mop bucket by placing the approved cleaner in the Chemical dispenser. Turn on the cold water to the dispenser and then turn the handle to fill the mop bucket • Dip the clean mop head into the cleaning solution and wring out until damp. Apply in an overlapping figure eight or S mopping pattern. Change the cleaning solution when it becomes heavily soiled. • Thoroughly rinse out your mop head, bucket and wringer and return them to the appropriate are. • Remove Wet Floor signs when floor is completely dry. 207 • Caution: - Slip or Fall could result if caution is not used when walking near or around an area that has been mopped. • To prevent back injuries, ask for assistance when lifting and emptying the mop bucket. c. Cleaning of Floors exposed to Human bodily fluid (blood, vomit, diarrhea, etc.) 1) Product: Agency Approved Cleaner (detergent) and Disinfectant 2) Equipment: • Wet Floor Signs • Plastic Mop Handle • Mop Bucket and Wringer • Clean Mop Head • protective gloves & goggles. 3) Assemble the Equipment • Remove any freestanding objects • Close off the area that needs to be cleaned • Post-Wet Floor Signs • Use all necessary safety equipment • Fill the mop bucket by placing the Bio Clean cleaner in the Sunburst Chemical dispenser. Turn on the cold water to the dispenser and then turn the handle to fill the mop bucket • Dip the clean mop head into the cleaning solution and wring out until damp. Apply in an overlapping figure eight or S mopping pattern. Change the cleaning solution when it becomes heavily soiled. • Thoroughly rinse out your mop head, bucket and wringer and return them to the appropriate are. • Fill the mop bucket by placing the Sentry cleaner in the Sunburst Chemical dispenser. Turn on the cold water to the dispenser and then turn the handle to fill the mop bucket. • Dip the clean mop head into the cleaning solution and wring out until damp. Apply in an overlapping figure eight or S mopping pattern. Change the cleaning solution when it becomes heavily soiled. • Remove Wet Floor signs when floor is completely dry. d. Cleaning of Counters & Hard Surfaces that have been exposed to Human bodily fluid (blood, vomit, diarrhea, etc.) 1) Product: Agency Approved Cleaner (detergent) and Disinfectant 2) Equipment: • Bio Clean and Sentry Spray bottles • cleaning rags • protective gloves & goggles. 3) Procedure • Assemble the Equipment • Remove any freestanding objects • Close off the area that needs to be cleaned • Post-Wet Floor Signs • Use all necessary safety equipment • Fill the Bio Clean spray bottle by placing the Bio Clean cleaner in the Sunburst Chemical dispenser. Turn on the cold water to the dispenser and then turn the handle to fill the spray bottle. • Spray the affected area with the Bio Clean cleaning solution and wipe/clean with a new cleaning rag • Clean the area from the highest point to the lowest point • Fill the Sentry Spray bottle by placing the Sentry cleaner in the Sunburst Chemical dispenser. • Turn on the cold water to the dispenser and then turn the handle to fill the spray bottle. 208 • • • Spray the affected area that has been cleaned with Bio Clean with the Sentry disinfecting solution and wipe clean with the cleaning rag. Be sure to follow the manufactures guidelines for applying the disinfectant solution. Change Rags whenever the rag becomes heavily soiled Remove wet floor sign after area is dry 209